The resource was developed by Diabetes UK to change both clinical and patient
behaviour. Collaborative design was used to ensure it was easy for clinicians to
use as a brief behaviour change intervention with patients who have diabetes
and are at higher risk of complications. The tool consists of three information
prescriptions (IPs), relating to the key targets in diabetes - HbA1c, blood pressure
and cholesterol. To maximise impact and reach, the team worked collaboratively with the
primary care IT companies to embed it in their systems. This enabled the proactive targeting
of high-risk patients as clinicians receive real-time alerts for patients with diabetes who are outside the NICE
targets. It also significantly increases the speed and effectiveness of the intervention as key patient data can be
automatically populated on the IPs and a completed IP is saved on the medical record to support continuity of care.
Data shows that we are not effectively supporting self-care: the latest National Diabetes Audit (2014-15) showed that
only 39.5% of people with diabetes achieve the targets for blood pressure, cholesterol and HbA1c. This is despite
these being the factors that place people at risk of devastating complications and the fact they are treatable with
routine drugs (eg statins) and lifestyle interventions. There was frustration among doctors and patients that the
number of tests and the pressures on time mean that diabetes care becomes nothing but a process of ticking boxes
with no opportunity to explore what matters to the patient or to change behaviour and therefore clinical outcomes.
To develop a tool that could reach patients across the UK and enable them to better understand and
engage with their diabetes care, with the ultimate goal of changing behaviour and clinical outcomes.
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